[Uberman5000]

Originally Posted by mvanz9999

Regarding the negative correlation between experience as an RN and practice as an NP, the article does point out a lack of understanding HOW Physicians are rating NPs (based on what - their own method of practice?)...because the medical vs. nursing model is very different.

This leads me to believe nurses with more clinical experience, have a more solid understanding of the nursing model. This puts them farther away from the standard medical model. So, if a physician attempts to train a seasoned RN, that person will have a stronger tendency to view things from a nursing model, which is contrary to the medical model. An inexperienced NP will not have a solid base in the theory of nursing, and is therefore much easier to train from the physician's viewpoint. Naturally, physicians will tend to rate inexperienced NPs higher, *from their point of view*.

I think that, in itself, makes the article very limited in scope, and not all that useful.

Hmm..I believe you are making a big assumption. I mean, if I wanted to assume things from the article...i could make the assumption that the reason why the seasoned nurses scored lower from the physicians standpoint is that they have been out of school longer and have not kept on top of their continuing education. So if I assume this, it makes sense to me why the younger nurses scored better in terms of how the collaborating physician rated their skills, the physician viewed them as more competant, i.e having a greater skillset. But this line of reasoning would be assumings things -- in looking on a whole -->

Did you look at the instrument used to analyze the data? The Nurse Practitioner Skills Inventory is reliable and valid with repect to assessing the skills of an NP, kind of hard to argue with that.

Also you are not examining the article collectively, you are taking one area of assessment(physicians), drawing a conclusion from an assumption and completely dispelling the other salient parameter by which nurses rated competancy(Self report).

No study can be perfect obviously and people see things in different ways. Regardless, this was a study whereby empirical data demonstrated that the level of competancy of an inexperienced APRN was on the level of an experienced APRN, i guess that is the bottom line.

[jjjoy]

Let's Bring the discussion back around to whether or not NPs need prior nursing experience to land a job. It seems that having prior experience is a definite advantage. Think about MBA programs. Those who have prior business experience generally have much better odds of using their new degree to nab a good job. Does that mean that if you don't have the prior experience there's no chance? Not at all. Just that it may be more difficult to get the job one wants after graduation. How difficult? I'm sure it varies so best to check it out and get some idea of what to expect.

[zenman]

Originally Posted by jjjoy

Let's Bring the discussion back around to whether or not NPs need prior nursing experience to land a job. It seems that having prior experience is a definite advantage. Think about MBA programs. Those who have prior business experience generally have much better odds of using their new degree to nab a good job. .

Good point..at least about some MBA programs. The one I went to required you to be in your 30s also. One guy at 29 was let in because he owned his own company!

[Sheri257]

Originally Posted by mvanz9999

Regarding the negative correlation between experience as an RN and practice as an NP, the article does point out a lack of understanding HOW Physicians are rating NPs (based on what - their own method of practice?)...because the medical vs. nursing model is very different.

This leads me to believe nurses with more clinical experience, have a more solid understanding of the nursing model. This puts them farther away from the standard medical model. So, if a physician attempts to train a seasoned RN, that person will have a stronger tendency to view things from a nursing model, which is contrary to the medical model. An inexperienced NP will not have a solid base in the theory of nursing, and is therefore much easier to train from the physician's viewpoint. Naturally, physicians will tend to rate inexperienced NPs higher, *from their point of view*.

I think that, in itself, makes the article very limited in scope, and not all that useful.

Thank you for this insight because it seemed very strange to me that NP's with more experience would actually be rated less favorably. You might expect them to be rated the same but worse? That would be truly bizarre. It doesn't make much sense.

[Sheri257]

Originally Posted by Uberman5000

Are you certain of this assertion? Nurse pracitioners are sued and found liable more than floor nurses? How can you be certain of this..i would like to see some empirical data on this.

According to this NSO newsletter published last year, it costs 2.5 times more, on average, to defend an NP than a staff RN in a lawsuit ($20K for an NP versus $8K for an RN).

http://www.nso.com/newsletters/advis...5/NSO05_NP.pdf

Severity claims for NP's also cost 25 percent more than the average RN claim in liability lawsuits.

Since they're paying more money to defend and cover NP liability cases, it seems pretty obvious to me that NP's are being found liable more than staff RN's. Of course, that makes sense with the additional responsibilities that NP's have.

So, getting back to the original topic at hand ... it seems logical that NP's with more nursing experience would probably be better ... due to the additional potential liability here.

[tntrn]

I have a good friend who decided about 3 years ago that she was going to become a nurse. More specifically, she had plans to get a BSN, then right into an MSN/NP program. It was immersion therapy I think, but she was successful and her first job is as one of 2 NP's in a brand-new clinic in an upscale neighborhood in this area. She got the job before the building was completed, and was going to get to give input as to what she wanted in the building, etc. That last bit I find hard to believe, having been asked that question before when our new FMC unit was built. My personal belief is that the corporation has a set of building plans and they use them, regardless of what they ask you.

But other than her clinical experience while a student, she's had absolutely no RN or any other kind of bedside nursing experience.

She walked away from graduation right into a NP position with no prior RN experience whatsoever: so it can be done.

And if she's treating infections, suturing lacerations, diagnosing the sniffles, I'm not sure bedside nursing care is really necessary.

[Blurr156]

Wow!!! Little did I know I was going to be starting such an active thread!!! I just got caught up on all the comments going on since my last post. Great discourse taking place. My thanks to all for their comments whether directly related to my original post or not. An update on my latest "school" plan, it appears that I won't be able to attend the program I was interested in next year because I haven't taken the GRE yet (and it is required for when you apply). Because of this, I might be redirecting my goal towards PA which I can still apply for next year. I am eager to move up in healthcare (along with the additional responsibilities, lawsuits be damned!! ). I again wish to thank everyone here for their comments and hope they continue to help others like myself. I will end this with one question for people here. I often hear about the "nursing" model vs. the "medical" model. Can someone explain in more detail what exactly that means? I think I have a rough idea, but I'm curious from what people here believe it means. Thanks and best to all whatever your endeavors!!!

[Uberman5000]

Originally Posted by lizz

Thank you for this insight because it seemed very strange to me that NP's with more experience would actually be rated less favorably. You might expect them to be rated the same but worse? That would be truly bizarre. It doesn't make much sense.

XXX
The point you are talking about in the study has to do with the way Physicians rated their collaborating NP's using an instrument that is both reliable and valid with respect to measuring the skills of a Nurse Practitioner. There are many ways this can be interpreted, but the end result is that the physicans rated nurses with more experience as less skilled as evidenced by the data gathered from the instrument. There was a second portion of the study which was the more critical area, the self evaluation which again, according to a reliable and valid instrument for measuring the skills of NP found that there was NO DIFFERENCE between the skill level in an experienced nurse and the skill level of a less experienced nurse, that is the bottom line of the study. XXX

[Uberman5000]

Originally Posted by lizz

According to this NSO newsletter published last year, it costs 2.5 times more, on average, to defend an NP than a staff RN in a lawsuit ($20K for an NP versus $8K for an RN).

Since they're paying more money to defend and cover NP liability cases, it seems pretty obvious to me that NP's are being found liable more than staff RN's. Of course, that makes sense with the additional responsibilities that NP's have.

Hmm, It seems you are jumping to conclusions. Here is what you are saying:


--> It costs more money to defend np = Greater frequency NP being sued

That is not what the article says, by any means. Nurse Practitioners have greater purview than RN's so their malpractice rate and liability WILL BE HIGHER. It doesnt mean that they get sued with greater frequency as you state.

Originally Posted by lizz

So, getting back to the original topic at hand ... it seems logical that NP's with more nursing experience would probably be better ... due to the additional potential liability here.

Again, I dont follow your logic. I have yet to see proof that Nurse Practitioners are sued with greater frequency than RN's, moreover I have yet to see proof that NPs with less experience are being sued MORE than NP's with more experience. Also we all have malpractice insurance dont we? Let the malpractice carrier worry about the liability, I am not going to be held hostage for the rest of my life because I am worried about getting sued.

[Uberman5000]

Originally Posted by tntrn

She walked away from graduation right into a NP position with no prior RN experience whatsoever: so it can be done.

And if she's treating infections, suturing lacerations, diagnosing the sniffles, I'm not sure bedside nursing care is really necessary.

Exactly TNTRN -- Great points made, it is done all the time. The problem is that you have the "good old boys" mentality and people who dont want you to do something because they didnt do it like that back in the day, for whatever reason, they think you should have to do the exact same thing they did. Like who would want to eat crap if they didnt have to you know what I mean?